Young
Adult Drinking

Too often today’s
headlines bring news of yet another alcohol-related tragedy involving a young
person—a case of fatal alcohol poisoning on a college campus or a late-night
drinking–driving crash. People ages 18 to 25 often are in the news, but
are they really at higher risk than anyone else for problems involving alcohol?

Some of the most important new data to emerge
on young adult drinking were collected through a recent nationwide survey, the
National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). According
to these data, in 2001–2002 about 70 percent of young adults in the United
States, or about 19 million people, consumed alcohol in the year preceding the
survey.

It’s not only that young people
are drinking but the way they drink that puts them at such high risk for alcohol-related
problems. Research consistently shows that people tend to drink the heaviest in
their late teens and early to mid-twenties (1,2). Young adults are especially
likely to binge drink and to drink heavily1 (3). (1 In this
study, binge drinking was defined as consuming five or more drinks in a row at
least once in the past month. Drinking heavily was defined as consuming five or
more drinks in a row on at least five occasions in the past month [3].) According
to NESARC data, about 46 percent of young adults (12.4 million) engaged in drinking
that exceeded the recommended daily limits2 at least once in the past
year, and 14.5 percent (3.9 million) had an average consumption that exceeded
the recommended weekly limits.3 (2 The recommended daily
limits for moderate alcohol consumption are no more than two drinks for men or
one drink for women per day [4].) (3 According to the National Institute
on Alcohol Abuse and Alcoholism [NIAAA], men may be at risk for alcohol-related
problems if their alcohol consumption exceeds 14 standard drinks per week or 4
drinks per day, and women may be at risk if they have more than 7 standard drinks
per week or 3 drinks per day. A standard drink is defined as one 12-ounce bottle
of beer, one 5-ounce glass of wine, or 1.5 ounces of distilled spirits.)

Such risky drinking often leads to tragic consequences (5)—most
notably alcohol-related traffic fatalities (6). Thirty-two percent of drivers
ages 16–20 who died in traffic crashes in 2003 had measurable alcohol in
their blood, and 51 percent of drivers ages 21–24 who died tested positive
for alcohol (7). Clearly, then, young adult drinkers pose a serious public health
threat, putting themselves and others at risk.

AN
AGE OF EXPLORATION

Young adulthood
is a stage of life marked by change and exploration. People move out of their
parents’ homes and into dormitories or houses with peers. They go to college,
begin to work full-time, and form serious relationships. They explore their own
identities and how they fit in the world. The roles of parents weaken and the
influences of peers gain greater strength. Young adults are on their own for the
first time, free to make their own decisions, including the decision to drink
alcohol.

Young adulthood also is the time during
which young people obtain the education and training they need for future careers.
Mastery of these endeavors is vital to future success; problems with school and
work can produce frustration and stress, which can lead to a variety of unhealthy
behaviors, including increased drinking. Conversely, alcohol use during this important
time of transition can impede the successful mastery of these developmental tasks
(8), also increasing stress.

ALCOHOL
AND THE MATURING BRAIN

Research shows
that the brain continues to develop throughout adolescence and well into young
adulthood. Many scientists are concerned that drinking during this critical developmental
period may lead to lifelong impairments in brain function, particularly as it
relates to memory, motor skills, and coordination (9). Young adults are particularly
likely to binge drink4 and to suffer repeated bouts of withdrawal from
alcohol. (4 NIAAA defines binge drinking as consuming about four drinks
for men or three drinks for women in about 2 hours.) This repeated withdrawal
may be a key reason for alcohol’s harmful effects on the brain (10).

Even though research shows that drinking early in life can lead to
impairment of brain function in adulthood, findings also show that not all young
people who drink heavily or become alcohol dependent will experience the same
level of impairment, and some may not show any damage at all (11). This is because
factors such as genetics, drinking patterns, and the use of other drugs also influence
risk.

FACTORS THAT
INFLUENCE USE

Outside influences
as well as individual characteristics help determine whether a person will begin
drinking and how much he or she will consume. Some of these factors increase a
person’s risk for problems with alcohol, whereas others serve to protect
him or her from harm, as outlined below.

Gender—Men
are much more likely than women to drink in ways that are harmful. As shown in
a recent national survey of 19- to 30-year-olds, 45 percent of men and 26.7 percent
of women reported heavy drinking (defined in that study as five or more drinks
on one occasion) in the past 2 weeks, and 7.4 percent of men and 3 percent of
women reported daily drinking (12).

Race/Ethnicity

Racial,
ethnic, and cultural differences in drinking and alcohol-related problems also
have been documented. In general, White and Native American young adults drink
more than African Americans and Asians, and drinking rates for Hispanics fall
in the middle. In addition, while drinking among Whites tends to peak around ages
19–22, heavy drinking among African Americans and Hispanics peaks later
and persists longer into adulthood (13). Researchers suggest that these ethnic
differences result, in part, from the fact that Whites see heavy drinking as part
of a youthful lifestyle, whereas Hispanics tend to see heavy drinking as a “right”
they earn when they reach maturity.

College vs. Noncollege Status

Many
people think that the college campus environment itself encourages heavy drinking
(14). Alcohol use is present at most college social functions, and many students
view college as a place to drink excessively. Yet several studies have found that
heavy drinking and related problems are pervasive among people in their early
twenties, regardless of whether they attend college or not (15,16). In fact, a
recent survey shows that college students drink less frequently than their noncollege
peers (that is, 3.7 percent of students report daily drinking vs. 4.5 percent
of nonstudents). However, when students do drink, such as at parties on the weekends,
they tend to drink in greater quantities than nonstudents5 (17). (5
In this study, 41.7 percent of college students vs. 37.1 percent of young adults
reported drinking five or more drinks during the last 2 weeks [17].)

On the other hand, students tend to stop these drinking practices
more quickly than nonstudents—perhaps “maturing out” of harmful
alcohol use before it becomes a long-term problem (16). Rates of alcohol dependence
diagnosis appear lower for college students than for 18- to 24-year-olds in the
general population (15). And people in their thirties who did not go to college
reported a higher prevalence of heavy drinking than people who did go to college
(18).

Employment

Being
employed full-time after high school was associated with a slight increase in
current drinking and a slight decrease in heavy drinking. Unemployed men, but
not women, especially tended to reduce their drinking. Homemakers reduced both
their current and heavy drinking, but this may have been because of increasing
responsibilities stemming from marital and parental roles rather than the result
of being a homemaker (19).

Military
Service

Young adults in the military are
more likely to drink heavily (i.e., consume five or more drinks per typical drinking
occasion at least once a week) than older enlistees. In 2002, 27 percent of adults
ages 18 to 25 in the military reported heavy drinking, compared with only 8.9
percent of those ages 26 to 55 (20). The reasons for heavy drinking rates in the
military include a workplace culture that supports alcohol use and the increased
availability of alcohol both in and around military bases (21).

Peer Influences

People
entering college or the workforce may be especially vulnerable to the influence
of peers because of their need to make new friendships. And they may increase
their drinking in order to gain acceptance by peers. Borsari and Carey (22) contend
that peer influence is exerted directly (in the form of drink offers or urges
to drink) and indirectly (by modeling perceived social norms).

The phenomenon of perceived social norms—or the belief that
“everyone” is drinking and drinking is acceptable—is one of
the strongest correlates of drinking among young adults, and the subject of considerable
research (15). Many college students think campus attitudes are much more permissive
toward drinking than they really are and believe other students drink much more
than they actually do (22–24). Recent research has shown that addressing
these misperceptions can help reduce drinking (24). Then again, the relationship
between drinking practices and peer groups may not be so clear. That is, a young
person may opt to join a peer group based on that group’s drinking practices
rather than change his or her drinking behavior to fit in with a particular peer
group (25).

Marriage
and Parenthood

Just as the move to adulthood
leads to greater exploration of the world and experimentation with alcohol, assuming
adult roles and responsibilities consistently curbs alcohol use. This reduction
in drinking may be a result of limitations that adult roles place on social activities
in general or may reflect a change in these young adults’ attitudes toward
drinking.

Young married women have the greatest
decreases in drinking behavior, and married men, compared with men in all other
categories of living arrangements (i.e., living with parents, in a dormitory,
alone, or in other arrangements) have the fewest increases. The data also indicate
that becoming engaged (i.e., making a commitment to a relationship) has a similar
but less powerful effect on drinking compared with marriage, whereas becoming
divorced leads to increased drinking behavior (19).

Being
a parent also is related to lower alcohol use for both men and women, although
a large part of this effect may simply be a result of getting married. Most women
who became pregnant eliminate their alcohol use, although most of their husbands
do not (19).

Young adults with serious alcohol
problems—that is, who fit the diagnostic criteria for alcohol dependence—may
not be as likely to choose stable roles such as marriage and parenthood, or these
milestones may not affect their drinking behavior to the same extent that they
affect people with less problematic drinking practices (26).

Personality Characteristics

A
number of personality traits have been associated with drinking greater amounts
of alcohol and drinking more often, including impulsivity, risk-taking, and sensation-seeking—or
the tendency to seek out new and exciting experiences (27). Sensation-seeking
and impulsivity also have been linked to deviant behavior and nonconformity, both
of which are predictors of heavy drinking and related problems among youth (28).

Then there are other personality traits, such as a feeling of invincibility,
that are common among young adults (27) and which can influence drinking. Many
young people simply do not see themselves as vulnerable to any negative consequences
that might occur because of drinking, such as having an accident or becoming dependent
on alcohol. This optimistic bias makes young adults more likely to take risks
and perhaps to drink excessively, although risk-taking may not be a direct cause
of drinking. That is, research shows that the decision to drink is influenced
more by the perceived benefits of drinking than by the perceived risks (29).

Negative moods, feelings of depression, and anxiety disorders also
may influence alcohol use (15). Research has suggested that some people drink
to relieve feelings of stress. In support of this, Cooper and colleagues (30)
found that drinking to cope with negative feelings was a good predictor of heavy
drinking as well as drinking problems in 19- to 25-year-olds. Again, though, research
also shows that young adults are more likely to drink for “positive”
or celebratory reasons than to drink to cope with negative feelings (31).

Alcohol Expectancies

Positive
alcohol expectancies, or the belief that drinking will lead to positive, pleasurable
experiences, play a key role in the drinking behavior of young adults. What a
person expects from drinking not only predicts when he or she will begin drinking
but also how much he or she will drink throughout young adulthood. As people age
through adolescence and into young adulthood, they increasingly expect benefits
from drinking and become less convinced of the risks (32,33).

Family Influences

During
young adulthood parents may have less direct influence on their children’s
drinking behavior, but they still play a major protective role (32). The example
set by parents with their own drinking has been shown to affect their children’s
drinking throughout their lifetime (34). Young people model their behavior after
their parents’ patterns of consumption (including quantity and frequency),
situations and contexts of use, attitudes regarding use, and expectancies. The
family’s structure and aspects of the parent–child relationship (e.g.,
parenting style, attachment and bonding, nurturance, abuse or neglect, conflict,
discipline, and monitoring) also have been linked to young people’s alcohol
use (34).

Genetics

Alcohol
problems seem to “run” in some families (34). This family connection
to alcoholism may be the result of a genetic link and/or may reflect the child’s
modeling of drinking behavior. Siblings also can influence drinking through modeling
and by providing access to alcohol (32). It’s unclear whether children of
alcoholics have different drinking patterns and problems in young adulthood than
those who do not have a family history of alcoholism (15). Research does show,
however, that people with a family history of alcoholism are less likely than
those with no family history to mature out of heavy drinking as they approach
young adulthood (35).

To better understand
the role of genetics in alcohol abuse and alcoholism, scientists are looking at
differences (or variants) in particular genes to see if they can be linked to
drinking behavior. One study examined how gene variants linked to the regulation
of serotonin—a key brain chemical involved in mood, appetite, emotion, and
addiction, among other processes—influenced drinking behavior in college
students. This study found that White students with a particular version of this
gene engaged in binge drinking more often, drank to intoxication more often, and
consumed more alcoholic drinks per drinking occasion than did students with other
variants of the gene (36).

Another study focused
on the gene that helps to form an enzyme (aldehyde dehydrogenase or ALDH) that
is important for breaking down alcohol in the body. This study reported that Asian
American college students who carried a particular version of the ALDH gene which
results in less efficient alcohol breakdown were less likely to be regular drinkers
and engage in binge-drinking episodes; they also reported a lower number of maximum
drinks consumed in a 24-hour period than Asian students with other ALDH variants
(37).

These studies are being complemented
by large-scale efforts to identify genes that contribute to alcoholism. One of
these projects, funded by the National Institute on Alcohol Abuse and Alcoholism,
is the Collaborative Study on the Genetics of Alcoholism (COGA). COGA researchers
recently published reports of several genes associated with alcohol dependence
in adults (38–40), and some of these findings already have been replicated
by other investigators (41–43). The next step will be to determine whether
these same genes are relevant to drinking behavior in adolescents and young adults.

By identifying specific genes influencing
alcohol abuse and alcoholism, scientists can begin to tease apart the complex
interplay that exists between genetic and environmental influences.

SIDEBAR

SCREENING AND BRIEF INTERVENTION

Because young
adults do not tend to identify themselves as having alcohol problems, proactive
screening is recommended (1). Such screening is especially effective in locations
where young adults are likely to seek treatment for alcohol-related injuries or
illness. Among 18- to 24-year-olds, these settings may include hospital emergency
departments, college counseling centers, or worksites. Screening also may be conducted
as part of college-sponsored judicial review programs for alcohol-related infractions
of campus policies.

Traditional alcohol education programs, which provide
information about the risks of alcohol use, take a variety of forms (e.g., individual
sessions, lectures, multisession groups). However, these approaches have not resulted
in reduced drinking, either in nonstudent or student populations (2,3). Given
the variety of drinking patterns evident in the young adult population and the
minimal effect of traditional alcohol education programs, more targeted, systematic
approaches are needed to help young adults recognize and reduce their hazardous
drinking.

Studies show that young adults who are drinking in ways that are
harmful or risky may respond better to brief, intensive interventions (4) than
to traditional long-term treatments, which originally were designed for adults
with longer histories of alcohol use and alcohol-related problems (5). Brief interventions
typically consist of one to four sessions with a trained interventionist (e.g.,
physician, psychologist, counselor), with each session ranging from several minutes
to up to an hour in length. These interventions are especially useful for people
who do not have severe drinking problems, which require more intensive treatment
(6).

An updated guide is now available from NIAAA to help clinicians identify
and help patients at risk for alcohol problems. For a free copy of Helping
Patients Who Drink Too Much: A Clinician’s Guide, visit the NIAAA Web
site (www.niaaa.nih.gov).

TRACKING
THE COURSE

Young adulthood is a time when many people establish
lifelong patterns of alcohol use (or nonuse). Others take a different course,
maybe drinking heavily in their late teens or young adult years, then maturing
out of risky alcohol use as they begin to assume more adult roles. By identifying
common tracks or trajectories of alcohol use and abuse across adolescence and
young adulthood, researchers are hoping to better understand how problems with
alcohol begin and how they are likely to develop over time in order to plan effective
prevention and intervention programs (44–46).

Studies of alcohol use
trajectories have yielded several important findings. For example, although the
majority of young adults report drinking some alcohol, anywhere from one-third
(47) to two-thirds (48) report that they never drink heavily.6 (6
The large variability cited here is attributed to differences in each study’s
characteristics, such as the sample of young adults tested and the definition
of heavy drinking used.) And most people tend to reduce their drinking by their
mid-twenties as they start to acquire adult roles, such as becoming a spouse,
parent, and worker.

The age when people begin drinking (especially heavy
drinking) has proven to be an especially good predictor of problems with alcohol
later in life. Interviews of adults consistently confirm a strong association
between an early initiation of drinking and later alcohol-related problems. People
who binge drink also are at higher risk for later alcohol problems. And young
adults who drink heavily are at particular risk for behavioral problems and may
have trouble adjusting to adult roles (18).

Maturing Out of
Alcohol Use—About 21 percent of young adults met the diagnostic
criteria for alcohol dependence or abuse in 2004 (3). Yet as they enter their
mid-twenties, studies show that many of those same young adults will stop or moderate
their drinking (35).

Despite the fact that young adults’ alcohol
use is in some sense “normal,” it still can be dangerous. Statistics
show that illness and death among young adults primarily result from lifestyle
choices and behaviors, including excessive alcohol use (49). Even one night of
heavy drinking can have serious consequences that persist well beyond adolescence
and young adulthood, such as alcohol-related car crashes, unintended pregnancies,
and physical assaults leading to arrest or jail (50).

PREVENTION
AND INTERVENTION

What researchers have learned about the different
trajectories that drinkers follow as they progress through young adulthood has
important implications for prevention. Studies have shown that (1) people follow
a variety of pathways across the adolescent and young adult years, (2) alcohol
use behaviors change differently for different people, and (3) factors that predict
alcohol use patterns emerge and disappear at different ages. One approach to prevention
simply will not fit every need. Recognizing the varied and ever-changing trajectories
that alcohol use can take offers scientists a solid developmental foundation on
which to build effective interventions (32).

One way to prevent alcohol-related
problems—among young people or the population as a whole—is to establish
policies that reduce overall alcohol consumption rates or reduce the rates of
high-risk drinking. Alcohol control policies influence the availability of alcohol,
the social messages about drinking that are conveyed by advertising and other
marketing approaches, and the enforcement of existing alcohol laws (51).

Most
alcohol control policies target either young people under the legal drinking age
of 21 or the drinking behavior of the population as a whole, rather than specific
subpopulations such as young adults. Nevertheless, some of these policies have
a larger effect on young adult drinkers compared with the rest of the population—for
example, measures that address drinking in bars and clubs, because young adults
are more likely than other age groups to patronize these establishments.

Prevention
on College Campuses—In recent years, an increasing number
of colleges have implemented policies to reduce alcohol consumption and alcohol-related
problems (14). Examples include establishing alcohol-free college residences and
campuses, prohibiting self-service of alcohol at campus events, prohibiting beer
kegs on campus, and banning sales or marketing of alcohol on campus. Though research
on the success of these programs is limited, studies have shown that students
living in substance-free residences are less likely to engage in heavy episodic
or binge drinking (five or more drinks in one sitting for men, four or more for
women), and underage students at colleges that ban alcohol are less likely to
engage in heavy episodic drinking and more likely to abstain from alcohol (52,53).
College alcohol policies are less likely to have an effect on students who live
off campus than on, however.

Prevention in the Military—Current
strategies to prevent alcohol problems among military personnel are similar to
strategies being used with other populations of drinkers, including instituting
and enforcing policies that regulate alcohol availability and pricing, deglamorizing
alcohol use, and promoting personal responsibility and overall good health (54).

Prevention Among the General Population—Some
of the principal strategies for influencing the drinking behavior of the general
population are raising taxes on alcoholic beverages, limiting the number of alcohol
establishments in a particular geographic area, training the staff of bars and
stores to sell alcohol responsibly, and restricting alcohol marketing and advertising.

Of these strategies, the effects of raising alcohol prices have been the
most extensively studied. The most common method of raising prices is to increase
Federal, State, or local taxes on alcoholic beverages. Studies show that underage
youth are particularly sensitive to increased prices, decreasing their alcohol
consumption by a greater amount than older drinkers (55). A few studies have looked
at how alcohol prices affect drinking among college students and young adults
(55). One study showed that college students faced with higher alcohol prices
were less likely to transition from being abstainers to moderate drinkers and
from moderate to heavy drinkers (56). Another study found that low sale prices
were associated with higher rates of heavy episodic drinking among college students
(57).

Prevention of Drinking and Driving—Traffic
crashes are the leading cause of death among teens, and more than half of drivers
ages 21–24 who died in traffic crashes in 2003 tested positive for alcohol
(7).

Raising the minimum legal drinking age (MLDA) to 21 has produced significant
reductions in traffic crashes among 18- to 20-year-olds, and it appears to have
had a spillover effect on the drinking behavior of 21- to 25-year-olds. One study
found that college students who had been high school seniors in States when the
MLDA was 18 drank more while in college than their counterparts who had been high
school seniors in States with an MLDA of 21. High school graduates of the same
age who were not attending college also drank more on average if they had been
seniors in States with an MLDA of 18 (58).

Another effective strategy
to reduce drinking–driving is to lower the legal limit for allowable blood
alcohol content (BAC) for drivers. In the past two decades, all States in the
United States have adopted a BAC limit of 0.08 percent for adult drivers and a
BAC limit of zero, or slightly higher, for youth under age 21. These often are
referred to as “zero tolerance” laws.7 (7 Most
laws use a 0.02-percent limit rather than an absolute zero limit to allow for
small measurement errors in BAC test instruments and to avoid challenges from
youth who claim they have taken medication with small amounts of alcohol.)

Studies have found that laws setting the legal allowable BAC at 0.08 percent have
resulted in 5-percent to 8-percent reductions in alcohol-related fatal traffic
crashes among all drivers (59–62). Laws setting the limit at 0.02 percent
have led to a 19-percent reduction in drinking–driving and a 20-percent
reduction in fatal traffic crashes among young drivers (63,64).

Comprehensive
Community Prevention Approaches—Perhaps the best way to reduce
harmful drinking and alcohol-related problems in young adults is through comprehensive
approaches that rely heavily on community action. Whether they are working, attending
college, or in the military, young adults typically are part of a community. And
young people’s usual sources of alcohol—retail outlets, restaurants,
bars, and social settings such as parties—also operate within the environment
of the community.

To be effective, community prevention interventions
require a mix of research-tested programs and policy strategies, along with strong
enforcement of those laws. Three NIAAA-sponsored community trial projects have
been extensively studied and are showing promise: The Saving Lives Project (65),
the Community Trials Project (66), and Communities Mobilizing for Change on Alcohol
(67). These trials provide strong evidence for the positive effects of research-based
local prevention efforts that take a comprehensive approach using a variety of
strategies.

CONCLUSION

Research
consistently shows that people tend to drink the heaviest in their late teens
and early to mid-twenties. This high level of alcohol use comes at an age when
people are moving away from parental restrictions but before they take on the
full responsibilities of adult life. As young people begin to assume more adult
roles—full-time employment, marriage, and parenthood—they often reduce
their drinking. This reduction in alcohol use may be a result of the limitations
that adult roles place on social activities or may reflect a change in young people’s
attitudes toward drinking.

Young adults who drink in ways that are especially
harmful—those who fit the diagnostic criteria for alcohol dependence—may
have predisposing personality characteristics and other factors that place them
at greater risk for problems with alcohol.

Prevention strategies that
may be especially useful in curbing young adult alcohol use are those that focus
on restricting the availability of alcohol. Such measures include raising the
cost of alcohol through taxes, limiting when and where alcohol can be consumed,
and enforcing policies that help to reduce problems such as drinking and driving.

Source
material for this Alcohol Alert originally appeared in Alcohol Research &
Health, Volume 28, Number 4, 2004/2005.

For more information on young
adult drinking, see also:

NIAAA’s recently redesigned Web
site, www.collegedrinkingprevention.org.
The site targets college students, high school students, their parents, and school
administrators. It features findings from the NIAAA Task Force on College Drinking
and interactive tools, such as calculators for determining the cost of alcohol,
the amount of calories in a drink, and for measuring blood alcohol concentration.
The “Interactive Body” allows viewers to trace alcohol’s flow
through the body and its effects on vital organs. E-cards also are offered, for
mailing to friends or to someone who might need a “wakeup” call about
the harmful effects of heavy drinking.

A Family History of
Alcoholism: Are You at Risk?, a brochure with basic information for anyone
who is concerned about a family history of alcoholism. It lists organizations
that can help relatives or friends of alcoholics. Available from www.niaaa.nih.gov

All material contained in the Alcohol Alert
is in the public domain and may be used or reproduced without permission from
NIAAA. Citation of the source is appreciated.
Copies of the Alcohol Alert
are available free of charge from the
National Institute on Alcohol Abuse
and Alcoholism Publications Distribution Center
P.O. Box 10686, Rockville,
MD 20849–0686.